1. Quality Standards for Melanoma 11 th October 2012 James Larkin FRCP PhDRoyal Marsden Hospital / Consultant Medical OncologistInstitute of Cancer Research London

2. Overview What are quality standards? How does this fit in to NICE? The Melanoma Taskforce Melanoma Pathway Expert Working Group Quality statements Conclusions and next steps

3. What are quality standards? NICE quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care Evidence-based; NHS and social care 22 at present; 19 in development E.g. breast, colorectal, lung, ovarian cancer; hip fracture, COPD, glaucoma, heart failure 100+ are in topic library for future development http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp

4. Purpose of NICE quality standards Patients, carers and the public can use NICE quality standards to provide information about the quality of care they should expect Health and social care professionals and public health practitioners can use the quality standards in clinical audit and governance reports or in professional development and validation Provider organisations can use the quality standards to provide high quality services for patient care and monitor quality improvements or to show successful performance in a national audit or inspection Commissioners may use the quality standards to ensure that high quality care is being commissioned through the contracting process or to incentivise provider performance by using the indicators in association with incentive payments such as Commissioning for Quality Improvement (CQUIN) http://www.nice.org.uk/guidance/qualitystandards/moreinfoaboutnicequalitystandards.jsp

5. Purpose of NICE quality standards Patients, carers and the public can use NICE quality standards to provide information about the quality of care they should expect Health and social care professionals and public health practitioners can use the quality standards in clinical audit and governance reports or in professional development and validation Provider organisations can use the quality standards to provide high quality services for patient care and monitor quality improvements or to show successful performance in a national audit or inspection Commissioners may use the quality standards to ensure that high quality care is being commissioned through the contracting process or to incentivise provider performance by using the indicators in association with incentive payments such as Commissioning for Quality Improvement (CQUIN) http://www.nice.org.uk/guidance/qualitystandards/moreinfoaboutnicequalitystandards.jsp

6. Cancer quality standards http://www.nice.org.uk/aboutnice/qualitystandards/qualitystandards.jsp Breast cancer (P) Breast cancer Colorectal cancer (P) Colorectal cancer Lung cancer (P) Lung cancer Ovarian cancer (P) Ovarian cancer Prostate cancer Cancer chemotherapy Haematological malignancies Head and neck cancer Sarcoma Skin cancer (including melanoma) Children and young people with cancer Metastatic spinal cord compression Referral for suspected cancer Radiotherapy services Bladder Cancer Published In topic library

7. Other types of NICE guidance Clinical guidelines Guidance on the appropriate treatment and care of people with specific diseases and conditions. Public health guidance NICE public health guidance makes recommendations to the NHS local authorities and other organisations in the public, private, voluntary and community sectors on how to improve people's health and prevent illness and disease. Technology appraisal guidance NICE technology appraisal guidance makes recommendations on when and how new and existing medicines and treatments should be used in the NHS. Interventional procedures guidance NICE interventional procedures guidance advises the NHS on whether new interventional procedures are safe and effective enough to be used routinely. Medical technologies guidance NICE Medical technologies guidance is designed to help the NHS adopt efficient and cost effective medical devices and diagnostics more rapidly and consistently. Diagnostic guidance NICE diagnostic guidance makes recommendations to the NHS on the efficacy and cost effectiveness of new diagnostic technologies. Cancer service guidance NICE cancer service guidance supports the implementation of The NHS Cancer Plan for England, and the NHS Plan for Wales Improving Health in Wales. Quality standards NICE Quality standards define the standard of healthcare that people can expect by indicating when a clinical treatment (or a set of clinical procedures) is highly effective cost effective and safe, and is viewed a a positive experience by patients http://www.nice.org.uk/guidance/index.jsp?action=byTopic&o=7165

8. Other types of NICE guidance Clinical guidelines Guidance on the appropriate treatment and care of people with specific diseases and conditions. Public health guidance NICE public health guidance makes recommendations to the NHS local authorities and other organisations in the public, private, voluntary and community sectors on how to improve people's health and prevent illness and disease. Technology appraisal guidance NICE technology appraisal guidance makes recommendations on when and how new and existing medicines and treatments should be used in the NHS. Interventional procedures guidance NICE interventional procedures guidance advises the NHS on whether new interventional procedures are safe and effective enough to be used routinely. Medical technologies guidance NICE Medical technologies guidance is designed to help the NHS adopt efficient and cost effective medical devices and diagnostics more rapidly and consistently. Diagnostic guidance NICE diagnostic guidance makes recommendations to the NHS on the efficacy and cost effectiveness of new diagnostic technologies. Cancer service guidance NICE cancer service guidance supports the implementation of The NHS Cancer Plan for England, and the NHS Plan for Wales Improving Health in Wales. Quality standards NICE Quality standards define the standard of healthcare that people can expect by indicating when a clinical treatment (or a set of clinical procedures) is highly effective cost effective and safe, and is viewed a a positive experience by patients http://www.nice.org.uk/guidance/index.jsp?action=byTopic&o=7165

9. What about clinical guidelines? 159 clinical guidelines on diverse topics including breast, lung, colorectal, prostate and ovarian cancers 61 in development including bladder cancer and melanoma (projected publication date June 2015) Lung cancer clinical guideline is 200 pages long! No planned guidance on oesophageal, stomach, pancreatic cancers or NHL (consider incidence and mortality) Hopefully melanoma quality standard will be developed alongside melanoma clinical guideline

10. The Melanoma Taskforce

12. Quality in Melanoma Care commissioned late in 2011

13. Melanoma Pathway Expert Working Group Simon Davies, Chief Executive Teenage Cancer Trust and Chair, Cancer52 Stephen Kownacki, Executive Chair, PCDS Charlotte Fionda, Development Director, Skcin Paul Lorigan, Medical Oncologist Jerry Marsden, Dermatologist and Chair, MSG Julia Newton-Bishop, Dermatologist and Chair, Skin Site Specific Clinical Reference Group, NCIN Gill Nuttall, Founder Factor50 Veronique Poirier, Principal Cancer Intelligence Analyst, SWPHO Barry Powell, Plastic Surgeon and National Clinical Advisor in Skin Cancer Saskia Reeken, Skin Cancer CNS and Chair, BDNG Daffyd Roberts, Dermatologist Neil Shroff, GPwSI Skin Cancer, Committee Member PCDS Meirion Thomas, Surgical Oncologist Jacky Turner, Principal Oncology Pharmacist, GSTT Catherine Wheelhouse, Skin Cancer CNS and Chair, British Association of Skin Cancer Specialist Nurses

14. Melanoma Pathway Expert Working Group Simon Davies, Chief Executive Teenage Cancer Trust and Chair, Cancer52 Stephen Kownacki, Executive Chair, PCDS Charlotte Fionda, Development Director, Skcin Paul Lorigan, Medical Oncologist Jerry Marsden, Dermatologist and Chair, MSG Julia Newton-Bishop, Dermatologist and Chair, Skin Site Specific Clinical Reference Group, NCIN Gill Nuttall, Founder Factor50 Veronique Poirier, Principal Cancer Intelligence Analyst, SWPHO Barry Powell, Plastic Surgeon and National Clinical Advisor in Skin Cancer Saskia Reeken, Skin Cancer CNS and Chair, BDNG Daffyd Roberts, Dermatologist Neil Shroff, GPwSI Skin Cancer, Committee Member PCDS Meirion Thomas, Surgical Oncologist Jacky Turner, Principal Oncology Pharmacist, GSTT Catherine Wheelhouse, Skin Cancer CNS and Chair, British Association of Skin Cancer Specialist Nurses Multidisciplinary and geographically representative

15. Melanoma Pathway Expert Working Group: Process Meetings in February and May 2012 Other work outside meetings 5 core teams (primary care, dermatology, surgery, oncology and survivorship/end of life care) Cross-cutting group reviewed work of teams Developed 16 quality statements and other recommendations; they describe the…

16. Quality Statements

20. Conclusions and next steps Positive that clinical guideline and quality standard planned for melanoma Hopefully the quality statements we have developed will be taken into account by the group working on these Whether there is any scope for this to inform quality of care before 2015 is unclear There may be disagreement about some of the statements but unity as a community is vital Comments and suggestions gratefully received

21. Acknowledgements Sian James MP Expert Working Group Secretariat, particularly Daniel Cambers and Katie Russell

22. Thank you

23. http://www.nice.org.uk/guidance/qualitystandards/moreinfoaboutnicequalitystandards.jsp#How are topics selected? How are quality standards developed?

24. http://www.nice.org.uk/guidance/qualitystandards/moreinfoaboutnicequalitystandards.jsp#How are topics selected?

25. Expert Recommendations